Health Services Technician

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

The remote work opportunity requires residency and work to be performed within the State of Arizona.

PURPOSE OF THE JOB

Responsible for research and triage of records and other documentation to ensure requests are processed accurately, timely, professionally and according to regulations. Works with team, providers and members to provide services that put our member first.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

Level 1/ 1 year

Level 2 / 3 years

Level 3 / 5 years

*Experience in healthcare, health insurance, or related customer service

2. Required Education

· High-School Diploma or GED in the general field of study (All Levels)

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

Level 1/ 2 years

Level 2 / 4 years

Level 3/ 6 years

*Experience in healthcare, health insurance, or related customer service

Level 1/ 1 year

Level 2 / 2 years

Level 3/ 3 years

* Experience in claims examination, health insurance, customer service, call center, medical office, or other healthcare-related field

2. Preferred Education

· Associate’s Degree in the general field of study

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

LEVEL 1 – Performs job functions under general supervision or peer review

· Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.

· Answer a diverse and high volume of health insurance customer calls or correspondence daily.

· Maintain complete and accurate records per department policy.

· confidentially maintains member information and ensures HIPAA compliance at all times.

· Meet quality, quantity and timeliness standards to achieve individual and departmental performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.

· Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, community resources, provider networks, etc..

· Demonstrate ability to apply plan policies and procedures effectively.

· Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.

· Research, gather and conduct preliminary analysis of data for department and corporate reporting.

· Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.

· Ensure confidentiality and control access to sensitive information.

· Maintains productivity and accuracy requirements set for this level.

· Assists in the development of procedures and or desk levels for assigned processes, as needed, and develops and assists in the implementation of new policies and or desk levels.

· Maintains effective communication (verbal and written), both formal and informal with internal and external customers.

· Maintains knowledge of activities in assigned area and possesses the ability to assist as necessary.

· Able to work effectively and collaboratively with interdisciplinary teams.

· Positively adapts to a changing work environment with flexibility and recognizes the impact the change will have on the department process.

· Adapts to changing work environment with flexibility and recognizes potential impact with ability to accentuate the positive to maintain/increase staff morale.

LEVEL 2 - Performs job functions with moderate supervision and peer review · When indicated to assist with team/project functions:

Collaborate with team to distribute workload/work tasks;

Monitor and report team tasks;

Communicate team issues and opportunities for improvement to supervisor/manager;

Support/mentor team members.

· Assists in departmental training of new staff and ongoing in-services.

· Assists in revising current policies and procedures and or desk levels, as needed and develops and assists in implementation of new policies and or desk levels.

· Attends and actively participates with interdepartmental teams.

· Takes on special projects as requested by management.

· Analyzes and monitors authorizations, requests or referrals for trends. These trends may illustrate an educational need; need for a referral to a different BCBSAZ department; need for updating a policy / guideline. Makes specific written recommendations to Manager with demonstrated ability to follow through on ideas.

LEVEL 3 - Performs job functions with minimal supervision

· Demonstrates ability, under minimal direction to perform special projects, train new staff, analyze inventory, revise current policies and procedures and or desk levels and develop and implement new policies and or desk levels.

· Takes initiative to follow through on issues and identifies opportunities for improvement.

· Consistently serves as a SME and resource to team members when questions arise regarding departmental policies and procedures.

· Demonstrates resourcefulness, diplomacy, organizational and analytical skills.

ALL LEVELS · Each progressive level includes the ability to perform the essential functions of any lower levels.

· The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

· Perform all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills (Applies to All Levels)

· Intermediate skill in use of office equipment including copier, fax machine, scanner, and telephones

· Intermediate PC proficiency

· Intermediate skill in word processing, spreadsheet, and database software

2. Required Professional Competencies (Applies to All Levels)

· Maintain confidentiality and privacy

· Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards

· Interpret and translate policies, procedures, programs and guidelines · Capable of investigative and analytical research

· Navigate, gather, input and maintain data records in multiple system applications

· Follow and accept instruction and direction

· Establish and maintain working relationships in a collaborative team environment

3. Required Leadership Experience and Competencies

· N/A

PREFERRED COMPETENCIES

1. Preferred Job Skills (Applies to All Levels)

· Intermediate understanding of medical terminology

· Intermediate comprehension of anatomy and medical practices

2. Preferred Professional Competencies (Applies to All Levels)

· Knowledge of a wide range of subjects about the organization’s service and operations

· Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data

3. Preferred Leadership Experience and Competencies (Applies to All Levels)

· Ability to build synergy and interdependence with a diverse team, in a changing environment

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.